Clinical features

The clinical features of achalasia include:

• gradually progressive, intermittent dysphagia to solids and liquids (1,2)
  • dysphagia associated with oesophageal carcinoma is more rapid and relentless than achalasia
  • insidious onset and progression prevents early presentation
• regurgitation of fluids from the oesophageal sac may be followed by an aspiration pneumonia or frank vomiting (1,2)
  • patient may have a history of recurrent respiratory tract infections
• heartburn is present in 27-42% of patients with achalasia (3)
  • may be initially misdiagnosed as gastroesophageal reflux disease (GERD) and treated with proton pump inhibitors (PPI)
• chest discomfort or pain
  • may be due to oesophageal distension

Reference:

1. Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol. 2018 Jul;12(7):711-721. doi: 10.1080/17474124.2018.1481748. Epub 2018 Jun 8. PMID: 29804476.
2. Momodu II, Wallen JM. Achalasia. [Updated 2021 Aug 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519515/ - article-17083.s4 (accessed 21 January 2022)
3. Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393-1411. doi: 10.14309/ajg.0000000000000731. PMID: 32773454.